The inventor of the polio vaccine, Jonas Salk, famously vowed never to limit access to his findings. “There is no patent,” he said. “Can you patent the sun?”
As the world grasps for access to new vaccines, treatments and testing for COVID-19, the questions that Salk posed are as relevant as ever. Can science be used in a way that prioritizes the health of some over others? Can profit be put before mutual trust and solidarity?
In regions like the Americas that have been particularly hurt by the pandemic, it is vital that everyone is able to benefit from the scientific advances that pharmaceutical companies are making. As we commemorate Universal Health Coverage Day today, the region’s governments must apply the lessons learned from previous pandemics and take steps to avoid past mistakes.
Home to a billion people, the Americas has the highest number of COVID-19 cases in the world. It is a land of cruel contrasts, with some of the planet’s wealthiest billionaires and millions of people struggling to eat each day.
According to the Pan American Health Organization, during the H1N1, or “swine flu” pandemic of 2009, the region’s richer countries acquired the vaccine first, leaving the rest to scramble for doses afterwards. The current story is looking very similar. Wealthier nations, such as the US and Canada, are putting themselves at the front of the queue and placing pre-orders for vaccine doses with pharmaceutical companies. Those countries with domestic manufacturing capacity and larger populations, like Argentina, Mexico and Brazil, also have advantages regarding opportunities to pre-order vaccines doses and prepare for distribution. This leaves smaller countries also critically hit by COVID with reduced possibilities of vaccine access for their populations.
Home to a billion people, the Americas has the highest number of COVID-19 cases in the world
Very few of the contracts that governments sign with companies are being published, even though local laws in many countries of the Americas require the details of public purchases to be made public. In August, the presidents of Mexico and Argentina announced that they had signed a deal with pharmaceutical giant AstraZeneca to jointly produce between 150 and 250 million doses of a COVID-19 vaccine that would be distributed to countries across the region. Four months after this deal was reached, and with vaccines almost on the doorstep of hospitals and clinics in the region, very little information has been made public about this deal, less still the distribution plan behind it. For example, we still do not know how many vaccine doses Mexico and Argentina purchased, at what price, according to what timeline.
Mexico has signed agreements with several pharmaceutical companies for enough vaccine doses to cover its population. None of these contracts have been made public, and so information about the price paid per dose, the cost of developing the vaccines, and the technology used in production remains hidden. Transparency is fundamental and essential so that the vaccine can be produced at low cost in Mexico and the rest of the region.
Brazil’s Fiocruz health institution provided an encouraging example when it published its terms of agreement with AztraZeneca in October. While further details on intellectual property and pricing could be included in the public version of the agreement, this was an important first step in the right direction.
In May, Costa Rica and the WHO launched the COVID-19 Technology Access Pool (C-TAP) as a voluntary sharing platform to pool all data, know-how, biological material and intellectual property, and then licence production and technology transfer to other potential producers. In a region like the Americas, mechanisms such as this are vital, especially as manufacturing capacity in many countries is very limited. In a sense, C-TAP embodies the spirit of Jonas Salk’s famous saying, ensuring that the knowledge generated by science is available for all, and that large manufacturing countries and smaller producers can use it alike.
The Americas is not only plagued by income inequality, but also inequality in access to health
While many states in the Americas have been key in supporting the C-TAP mechanism, several remain silent, including the USA, Canada, Colombia, Venezuela, Cuba and Nicaragua. More importantly, no country has required companies to join the C-TAP mechanism as a pre-condition to signing purchase agreements for vaccine doses. In many cases, countries are looking to international trade rules, and national legislation, which often enforce exclusive licencing, or patent rules, to preserve trade secrets and scientific knowledge of companies.
These trade rules do not need to be a straitjacket that keeps this information shrouded in secrecy, inhibiting the low-cost availability of vaccines, treatments and testing. The World Trade Organization’s General Council will meet on 17 December to decide on a proposal put forward by the governments of India and South Africa in October, that would allow countries to neither grant nor enforce patents and other specific intellectual property rights (such as patents and licencing) related to COVID-19 products until global herd immunity is achieved. Some countries in the Americas have openly opposed this proposal, such as Brazil, Canada and the USA. Other major players like Mexico are still on the fence.
The Americas is not only plagued by income inequality, but also inequality in access to health. Indigenous peoples, communities of colour, migrant and refugee communities, people living in informal settlements, and women, are all among groups whose access to health is undermined by pre-existing social conditions that affect them disproportionately. If countries in the region do not set an example by working together and garnering scientific knowledge to the benefit of all, these marginalized populations – especially in poorer countries – will continue to bear the brunt of this gruelling pandemic, which has seen the longest lockdowns in the world in this hemisphere.
The nations of the Americas must work together to ensure to one is left behind in providing COVID-19 vaccines, treatments and testing for all. It is time that they call on companies to engage with the C-TAP mechanism and pledge support for the proposal to waiver medical products from WTO trade rules. The only way to put COVID-19 behind us is if we ensure we are all in this together, and this means making vaccines fair for everyone.